HHS Releases Final Rules for Medicaid Expansion

Today, Health and Human Services released the final rules for the Medicaid coverage expansion effective January 2014. The expansion increases the income-eligibility for Medicaid up to 133% FPL ($14, 856 for an individual, $30,656 for a family of four) for individuals between the ages of 19 and 64. The final rules support the ACA by doing each of the following:

Expanding Eligibility with Federal Support: The federal government will fund 100% of the cost of coverage expansion for those newly eligible for the first three years (CY 2014-2016), which reduces to 90% in the years thereafter.

Simplifying and Streamlining Eligibility, Enrollment, and Renewal Processes: The eligibility, enrollment and renewal processes for Medicaid and CHIP will be modernized by relying on Modified Adjusted Gross Income (MAGI) standards and consolidating eligibility categories to include adults, children, parents, and pregnant women.

The final rules also improve the Medicaid eligibility process by relying on electronic data sources and allowing States access to a federal services data “Hub” for verification purposes. The renewal process will be limited to once every 12 months unless an individual reports a change or agencies have reason to reassess eligibility.

Coordinating Sources of Care: The final rules provide flexibility in eligibility determinations by promoting coordination between Affordable Insurance Exchanges, Medicaid, and CHIP. State Exchanges will have the option of choosing from two different Medicaid-eligibility evaluations.

The final rules also reflect public comment by allowing persons with disabilities or those in need of long-term services and support to enroll in an existing Medicaid category to ensure timely enrollment. Public comment was solicited after the proposed rules were released on August 17, 2011. The final rules also include consumer protections that were not outlined in the previous proposal.